The United States (US), which has the most expensive health care infrastructure in the world, remains, by far, the country most affected by the coronavirus pandemic with more than 3.5 million cases and around 140,000 fatalities as of July 15. Sadly, more than six months after the onset of the pandemic, the US appears to be far from flattening the infections curve.
These problematic conditions were created by a seriously flawed response to Covid-19 from its initial identification until today. There were 10 major deficiencies, all of which provide lessons on what not to do.
One, decisions were made politically, rather than scientifically. This failure began at the top with President Donald Trump. He was initially dismissive of the coronavirus comparing it to the seasonal flu. He appointed Vice-President (V-P) Mike Pence to head a task force to advise on what to do but gave it no real authority.
Two, no national plan, backed by law, was devised to address the pandemic. The V-P’s task force developed guidelines for states and localities for testing, tracking and treatment of the virus; sheltering in place; and, the use of masks and social distancing to prevent its spread. These were only guidelines, not mandatory rules or law.
Three, the pandemic was treated as a state and local issue. There was no standardised federal intervention on the pandemic. The governors and local officials were made responsible for handling it. As a result, the approaches and results varied considerably from state to state.
Four, there was limited national access to testing, medical equipment and supplies. The federal government furnished a nominal amount of these, but the supplies and supply chain were woefully insufficient. The states were left to source these, and fought among themselves, to acquire these materials from overseas and private sources.
Five, there were mixed messages related to the pandemic. The task force held regular briefings until the country began to reopen and Trump essentially silenced it. He commandeered those briefings and used them to grandstand, argue with the press, contradict the medical experts, and even promote unproven drugs.
Six, there was a push towards a rapid reopening. Trump was always opposed to sheltering in place. He started suggesting considering reopening the country shortly after people started staying at home. He also tweeted to his millions of followers to liberate states such as Virginia and Michigan where he felt the governors might resist or be too slow in reopening. Trump appeared to be driven solely by his re-election possibilities, at the cost of public health.
Seven, reopening one part, based on relative success in another, ignored the nature of the disease. The original hotspots for the pandemic were primarily states and urban cities in the Northeast and Midwest and in California. By mid-May to early June, the spread was weakening in those locations and appeared to have peaked around the country. So states such as Georgia, Florida, Texas and Arizona moved ahead with relatively rapid re-opening. As a consequence, they became and are the new hot spots.
Eight, the US had no uniform enforcement mechanisms. The extent to which states enforced sheltering at home, wearing of masks and social distancing varied sharply. In some states such as Georgia and Texas with Republican governors and large cities with Democratic mayors, the governors only recommended these actions to battle Covid-19, while the mayors required them by law.
Nine, a misplaced prioritisation of economic concerns over health concerns. The reopenings were done almost solely to stimulate the economy which had cratered due to the pandemic. This had huge costs.
Ten, and perhaps most important, there has been the consistent rejection and discounting of expert advice. From the outset, Trump minimised the advice of experts such as internationally-renowned infectious disease and task force member Dr Anthony Fauci, and constructed his own alternative version of reality.
Overall and with a few exceptions in hard-hit states where individual governors demonstrated leadership, the US has managed Covid-19 reactively rather than proactively. A large part of this failure must be attributed to Trump who, after months of not wearing a mask, has only recently been seen in public wearing one, and who continues to insist that, at some point, the pandemic will just disappear.
Trump is a role model of what not to do personally, politically and professionally in response to a pandemic. His coronavirus playbook is a template for current and future national leaders on how not to fight a pandemic.
These are the primary lessons that India and other countries can learn from the US’ disastrous handling of this situation. India must pay heed, as cases are continuing to rise, indicating that possibly the toughest lockdown in the world did not yield the outcomes that had been anticipated. Sometime shortly, India will pass the grim milestone of one million cases to become the third nation to do so, after the US and Brazil.
That is bad news for India. There is a silver lining in the cloud though. That is because of its much lower fatality rate. Moreover, according to Indian government officials, 80% of active cases are from 49 of the country’s 720 districts, which mean a vast majority of the cases are restricted to less than seven per cent of the districts. By taking a targeted approach to testing, tracking and treatment to flatten the curve in these hot spots and ensuring no spread beyond these areas, the impact of the pandemic can be minimised going forward.
Frank F Islam is an entrepreneur, civic leader, and thought leader based in Washington DC
The views expressed are personal